=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518870773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER A DIPAOLO CPO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2970 UNIVERSITY PKWY STE 105
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34243-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-384-7291
-----------------------------------------------------
Fax | 941-431-8661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5621 WHISPERING WILLOW WAY
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-384-7291
-----------------------------------------------------
Fax | 941-431-8661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | POR180
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------